Research on Obstacles to Segmented Reimbursement of Medical Insurance in Tight City Medical Groups Based on Grounded Theory
- VernacularTitle:基于扎根理论的紧密型城市医疗集团医保分段报销阻碍因素研究
- Author:
Li ZHANG
1
;
Ye HAN
;
Yilan ZHU
Author Information
1. 苏州大学附属第一医院 江苏 苏州 215006
- Publication Type:Journal Article
- Keywords:
tight urban medical group;
rooted theory;
segmented reimbursement of medical insurance;
medical insurance package payment
- From:
Chinese Health Economics
2024;43(12):23-26,32
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the obstacles of medical insurance package payment and segmented reimbursement in compact urban medical groups,and provide reference basis for the implementation of medical insurance policies. Methods:Using grounded theory for topic coding,and conducting analysis of variance to investigate whether economic factors lead to differences in hindering factors. Results:The coding results obtained 4 core categories,9 main categories,and 30 sub categories,with the core categories being top-level design,execution ability,allocation of rights and responsibilities,and supervision. The results of the analysis of variance indicated that the level of economic development did not lead to significant differences in hindering factors. Conclusion:To overcome the obstacles to medical insurance reform,government departments,as leaders,should play a good role in the policy combination blow. Medical groups should establish a unified information platform,facilitate dual-way referrals and establish incentive and constraint mechanisms. Medical institutions should refine cost management,optimize performance evaluation plans,improve medical insurance business financial management,etc.,to promote the reform of medical insurance payment methods,and to promote the improvement and development of hierarchical diagnosis and treatment.
